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psykitsuneWe admitted we were powerless over the effects of addiction—that our lives had become unmanageable.” Step One. AA (Friends in Recovery, 1989, p.3)
The term addiction has a notable quantity of categorical fluidity; while biological maladies such as blindness are objectifiable consequences of inheritable genetic traits or retinal damage, addiction has no singular quantifiable cause. Indeed, from its earliest conceptions as demonic possession of individuals (Allgeier, 1996) to a moral failure in the Opium War (Harding, 1986) addiction has been tied as much to societal changes as to individual phenomenology, the biological apparatus notwithstanding.
Hence, this essay will endeavour to elucidate a theoretical causality of addictive phenomena from a disease etiology. From there on, it will examine a model of treatment within this stratum of belief. Further, some reflections pertaining to the writer’s role play are included.
Addiction is theorised to arise from a positive reward, negative withdrawal, anticipatory preoccupation feedback loop in the brain (Hyman, 2005) —the dopamine model itself, nevertheless, does not explain the causality of the addictive behavioural particularly. One can consider this model like a microphone placed against a speaker, that each successive intake of dopamine builds on the next growing more powerful over time. However, this theory has been challenged given that the dopamine circuits can become acclimatised to the positive hit (Volkow, 1997) and thus experience less euphoria from every dose (Volkow, Koob &, McLellan, 2016).
This presents the disease model with a uniqueness amongst other illness as it involves a complex array subcortical and cortical processes alongside an interaction that is dependent on environmental issues, and genetics (American Society of Addiction Medicine, 2019). Fundamentally, when one considers the opposing model, defining addiction as a behavioural problem is complicated by characterising brain events being causative to addictive behaviours, or any behaviour, as such. The link between dopamine and reward mechanisms within the higher cortex is--despite its central role is not the whole story for all addictive drugs--(Hyman, 2005, pg.1451) and there are other neuroreceptors, including opioids themselves, that are shown to correlate positively with addictive behaviours. Discussions pertaining to this line of thought challenge specific philosophical conceptions concerning free will, personal responsibility (Volkow, Koob &, McLellan, 2016) and intrinsic intentionality, indicating that addiction, as such, is a phenomenon comprised of many different causes. Nevertheless, how can addiction be called a disease when its exact primal mechanisms are still partially unknown?
Bob Wilson of AA was the first to publicly call addiction a disease (Close, et al., 2019), primarily due to the nature of the 12-step program which declares that “that the individual is powerless, and that to achieve abstinence and sanity, a Higher Power must be sought,” (Dossett, 2013, pg. 373) This declaration assumes that the addiction exists a priori to an individual’s behaviour and that an alcoholic cannot mitigate his or her relationship to alcohol expect to completely remove it from his or her system. Genetically, it has been determined that there are certain genetic vulnerabilities that can cause addiction (Abraha, & Cusi, 2012) but this is not to say that addiction is a genetic problem either, as while a gene may carry a “code” for addiction, a gene may, a, only expresses a tiny minority of its total code and, b, the expression as such is still not fully understood (National Institutes of Health, 2019).
Take the example of glaucoma. Glaucoma can be categorised as “a disease” that can be objectively tracked through the successive loss of peripheral vision due to a progressive increase in intraocular pressure (Danesh-Meyer, & Levin, 2015), and juxtapose this to addiction where there is no directly comparative, measurable biological-phenomena that enables an addiction counsellor to diagnose the disease and observe its progression. Rather it is social, moral, familial, and personal, analysis that can lead to treatment.
However, the statement "People choose to be acholic" or" Peoples behaviours lead to alcoholism" is a moral judgement stemming from a political, historical or ideological perspective (Hitchens, 2020; Harding, 1986). This ignores the prevalence of other sociological problems. Indeed, studies in countries such as Ireland that show a correlation between early school leaders and in-prison treatment (Cannon, Nally, Collins, Fay, & Lyons, 2019) and while drug and alcohol taking is prevalent across class (Close et al., 2020) its environmental effects as regards to crime are felt in mostly in disadvantaged communities.
Hence, while the term disease may not accurately reflect the etiological cause and effect of addiction as an illness, it reflects a larger and holistic approach (Dodes, 2011) that instead of treating a deviant behaviour, it postulates that addiction can be “managed” in a similar fashion as glaucoma whereby the pressures of the drug itself can be negated while at the same time recognising that the addictive potential has no universally applicable cure.
It would be remiss for any essay on addiction not to mention the AA (Alcoholics Anonymous). AA was founded in America during the stock market crash of 1928, drawing a succession of lawyers, miners, salarymen from all manner of walks to combat their collective unhealthy relationship with alcohol. Through successive iterations of varying religious phenotypes, the Modern AA program is outlaid in the Big Book otherwise known as Alcoholics Anonymous (Kurtz, 1982). Bill Wilson, co-founder of the AA describes his battles with alcohol
Near the end of that bleak November, I sat drinking in my kitchen.…there was enough gin concealed about the house to carry me through that night and the next day, (AAWS 2001, pg.3)
While this may sound opaque, often in recovery, it is through the recognition of the problem with do AA members, “achieve the continuing independence of freedom from addiction to alcohol,” (Kurtz, 1982, pg.33)
If not uniquely but certainly effectively, AA combines techniques such as comradery—AA is a fellowship—role models—one is asked to seek a sponsor to provide encouragement and support—spiritual awareness—such as the surrendering to a higher power (Dossett, 2013)— and total abstinence. These faucets bring together a methodology that has observable effects at decreasing substance abuse (Humphreys, Blodgett, Wagner, 2014). AA places substantial emphasis on the acholic being powerlessness over his or her addiction and that is through a journey, through the 12 steps (see image above) one can achieve sobriety or recovery (Friends in Recovery, 1989). Powerlessness is not used to deride members or even superimpose a moral or religious judgement on members, nor does AA officially confer the term disease to alcoholism, rather treats alcoholism as an illness that can be managed but not cured (Alcoholics Anonymous World Services, 2017).
AA has been shown to be as effective as other forms of intervention (Abraha, & Cusi, 2012) and a detailed review of AA literature found that abstinence was two times higher amongst those who attended AA meetings (Kaskutas, 2009) while also leading to a short to long term decrease in consumption (Humphreys, Blodgett, Wagner 2014). Although the confidentiality of meetings makes empirical research difficult (Vaillant, 2005) one can argue that this total anonymity allows for all manners of individuals from all walks of live manage and recover from their illness without social or class restraints.
The language of AA is indeed spiritual;one cannot deny that AA was founded on Christian principles (Kurtz, 1982)—and as a result has contributed to cult accusations against the Fellowship (Alexander & Rollins, 1984). However, in a letter to Bill Wilson, Dr. C.G Jung writes, “An ordinary man, not protected by an action from above and isolated in society, cannot resist the power of evil,” (Jung & May, 1963, pg.3) In other words, an individual is not moved by his or her volition, neurology or behaviour alone, and, despite the arguments made from secular quarters, the AA model works by facilitating sobriety through the surrendering to, or directing towards, a higher power, purpose, or meaning (Friends in Recovery, 1989).
This essay has examined one perspective of the fundamental associations between addiction and its causality. While there exist other models that describe addiction differently, and more may someday be theorised, the postulation that addiction is an illness stemming from a multifaceted network of modalities—neurological, genetic, and social—is a model that benefits from a diverse church of causes that allow for treatment. Rather than attributing addiction to one’s behaviour, we have seen how AA encourages both acceptance and surrender as a priori prerequisites for the successful management of a disease that is innate to the addict’s neurophysiology.
AAWS. (2001). Alcoholics Anonymous. Alcoholics Anonymous World Services.
Abraha, I., & Cusi, C. (2012). Alcoholics Anonymous and Other 12-Step Programmes for Alcohol Dependence1. Alcohol and Drug Misuse, 8–9. https://doi.org/10.1002/9781118454503.ch3
Alcoholics Anonymous World Services, I. (2017). This Is A.A....an introduction to the A.A. recovery program (p. 24). AA Grapevine, Inc. https://www.aa.org/assets/en_US/p-1_thisisaa1.pdf
Alexander, F., & Rollins, M. (1984). Alcoholics Anonymous: the unseen cult. California Sociologist, 7(1), 33-48.
Allgeier, A. (1996). Sexual Addiction: Disease or Denigration ? The Journal of Sex Research, 33(2), 166.
American Society of Addiction Medicine. (2019). Definition of Addiction. Retrieved January 2, 2020, from https://www.asam.org/resources/definition-of-addiction
Close, L., Thomas, S., Kelley, R., Stein, S., Osbourne, N., & Ackermann, K. (2020). Why Addiction Is Considered a Disease - Recovery First Treatment Center. Retrieved 2 January 2020, from https://www.recoveryfirst.org/why-addiction-is-a-disease/
Danesh-Meyer, H. V., & Levin, L. A. (2015). Glaucoma as a neurodegenerative disease. Journal of Neuro-Ophthalmology, 35, S22–S28. https://doi.org/10.1097/WNO.0000000000000293
Dodes , L. (2011, December 17). Is Addiction Really a Disease? Retrieved January 2, 2020, from https://www.psychologytoday.com/us/blog/the-heart-addiction/201112/is-addiction-really-disease.
Dossett, W. (2013). Addiction, spirituality and 12-step programmes. International Social Work, 56(3), 369–383. https://doi.org/10.1177/0020872813475689
Friends in Recovery. (1989). The 12 Steps for Adult Children (2nd ed.). San Diego Recovery Publications, Inc.
Harding, G. (1986). Constructing addiction as a moral failing. Sociology of Health & Illness, 8(1), 75–85.
Hitchens, P. (2020). PETER HITCHENS: Think flogging drug dealers is barbaric? We could soon be doing MUCH worse here - Mail Online - Peter Hitchens blog. Retrieved 2 January 2020, from https://hitchensblog.mailonsunday.co.uk/2019/01/peter-hitchens-think-flogging-drug-dealers-is-barbaric-we-could-soon-be-doing-much-worse-here-1.html
Humphreys, K., Blodgett, J. C., & Wagner, T. H. (2014). Estimating the efficacy of alcoholics anonymous without self-selection bias: An instrumental variables re-analysis of randomized clinical trials. Alcoholism: Clinical and Experimental Research, 38(11), 2688–2694. https://doi.org/10.1111/acer.12557
Humphreys, K., Blodgett, J. C., & Wagner, T. H. (2014). Estimating the efficacy of alcoholics anonymous without self-selection bias: An instrumental variables re-analysis of randomized clinical trials. Alcoholism: Clinical and Experimental Research, 38(11), 2688–2694. https://doi.org/10.1111/acer.12557
Hyman, S. E. (2005). Addiction: A disease of learning and memory. American Journal of Psychiatry, 162(8), 1414–1422. https://doi.org/10.1176/appi.ajp.162.8.1414
Jung, D. C., & May, I. (1963). The Bill W.—Carl Jung Letters. AA Grapevine, 19(8), 2.
Kaskutas, L. A. (2009). Alcoholics Anonymous effectiveness: Faith meets science. Journal of addictive diseases, 28(2), 145-157.
Kurtz, E. (1982). Why A.A. works. The intellectual significance of Alcoholics Anonymous. Journal of Studies on Alcohol, 43(1), 38–80. https://doi.org/10.15288/jsa.1982.43.38
Matthews, D. (2019, April 28). The black/white marijuana arrest gap, in nine charts. Retrieved January 2, 2020, from https://www.washingtonpost.com/news/wonk/wp/2013/06/04/the-blackwhite-marijuana-arrest-gap-in-nine-charts/.
McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness implications for treatment, insurance, and outcomes evaluation. Journal of the American Medical Association, 284(13), 1689–1695. https://doi.org/10.1001/jama.284.13.1689
Monico, N. Thomas, S. (2019). The 12 Steps Of AA | Alcoholics Anonymous Program. Retrieved 7 January 2020, from https://www.alcohol.org/alcoholics-anonymous/
National Institutes of Health. (2019). How Genes Work. In U.S. National Library of Medicine (Ed.), Help Me Understand Genetics. Lister Hill: Department of Health & Human Services. Retrieved from https://ghr.nlm.nih.gov/
Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374(4), 363–371. https://doi.org/10.1056/NEJMra1511480
Volkow, N. D., Wang, G. J., Fowler, J. S., Logan, J., Gatley, S. J.,
Hitzemann, R., ... & Pappas, N. (1997). Decreased striatal dopaminergic responsiveness in detoxified cocaine-dependent subjects. Nature, 386(6627), 830.
Introduction
The term addiction has a notable quantity of categorical fluidity; while biological maladies such as blindness are objectifiable consequences of inheritable genetic traits or retinal damage, addiction has no singular quantifiable cause. Indeed, from its earliest conceptions as demonic possession of individuals (Allgeier, 1996) to a moral failure in the Opium War (Harding, 1986) addiction has been tied as much to societal changes as to individual phenomenology, the biological apparatus notwithstanding.
Hence, this essay will endeavour to elucidate a theoretical causality of addictive phenomena from a disease etiology. From there on, it will examine a model of treatment within this stratum of belief. Further, some reflections pertaining to the writer’s role play are included.
The Etiology of a Disease Model for Addiction
Addiction is theorised to arise from a positive reward, negative withdrawal, anticipatory preoccupation feedback loop in the brain (Hyman, 2005) —the dopamine model itself, nevertheless, does not explain the causality of the addictive behavioural particularly. One can consider this model like a microphone placed against a speaker, that each successive intake of dopamine builds on the next growing more powerful over time. However, this theory has been challenged given that the dopamine circuits can become acclimatised to the positive hit (Volkow, 1997) and thus experience less euphoria from every dose (Volkow, Koob &, McLellan, 2016).
This presents the disease model with a uniqueness amongst other illness as it involves a complex array subcortical and cortical processes alongside an interaction that is dependent on environmental issues, and genetics (American Society of Addiction Medicine, 2019). Fundamentally, when one considers the opposing model, defining addiction as a behavioural problem is complicated by characterising brain events being causative to addictive behaviours, or any behaviour, as such. The link between dopamine and reward mechanisms within the higher cortex is--despite its central role is not the whole story for all addictive drugs--(Hyman, 2005, pg.1451) and there are other neuroreceptors, including opioids themselves, that are shown to correlate positively with addictive behaviours. Discussions pertaining to this line of thought challenge specific philosophical conceptions concerning free will, personal responsibility (Volkow, Koob &, McLellan, 2016) and intrinsic intentionality, indicating that addiction, as such, is a phenomenon comprised of many different causes. Nevertheless, how can addiction be called a disease when its exact primal mechanisms are still partially unknown?
Bob Wilson of AA was the first to publicly call addiction a disease (Close, et al., 2019), primarily due to the nature of the 12-step program which declares that “that the individual is powerless, and that to achieve abstinence and sanity, a Higher Power must be sought,” (Dossett, 2013, pg. 373) This declaration assumes that the addiction exists a priori to an individual’s behaviour and that an alcoholic cannot mitigate his or her relationship to alcohol expect to completely remove it from his or her system. Genetically, it has been determined that there are certain genetic vulnerabilities that can cause addiction (Abraha, & Cusi, 2012) but this is not to say that addiction is a genetic problem either, as while a gene may carry a “code” for addiction, a gene may, a, only expresses a tiny minority of its total code and, b, the expression as such is still not fully understood (National Institutes of Health, 2019).
Take the example of glaucoma. Glaucoma can be categorised as “a disease” that can be objectively tracked through the successive loss of peripheral vision due to a progressive increase in intraocular pressure (Danesh-Meyer, & Levin, 2015), and juxtapose this to addiction where there is no directly comparative, measurable biological-phenomena that enables an addiction counsellor to diagnose the disease and observe its progression. Rather it is social, moral, familial, and personal, analysis that can lead to treatment.
However, the statement "People choose to be acholic" or" Peoples behaviours lead to alcoholism" is a moral judgement stemming from a political, historical or ideological perspective (Hitchens, 2020; Harding, 1986). This ignores the prevalence of other sociological problems. Indeed, studies in countries such as Ireland that show a correlation between early school leaders and in-prison treatment (Cannon, Nally, Collins, Fay, & Lyons, 2019) and while drug and alcohol taking is prevalent across class (Close et al., 2020) its environmental effects as regards to crime are felt in mostly in disadvantaged communities.
Hence, while the term disease may not accurately reflect the etiological cause and effect of addiction as an illness, it reflects a larger and holistic approach (Dodes, 2011) that instead of treating a deviant behaviour, it postulates that addiction can be “managed” in a similar fashion as glaucoma whereby the pressures of the drug itself can be negated while at the same time recognising that the addictive potential has no universally applicable cure.
The Disease Model: Evidence-Based Approaches to Treatment
AA (Alcoholics Anonymous): Pioneers
It would be remiss for any essay on addiction not to mention the AA (Alcoholics Anonymous). AA was founded in America during the stock market crash of 1928, drawing a succession of lawyers, miners, salarymen from all manner of walks to combat their collective unhealthy relationship with alcohol. Through successive iterations of varying religious phenotypes, the Modern AA program is outlaid in the Big Book otherwise known as Alcoholics Anonymous (Kurtz, 1982). Bill Wilson, co-founder of the AA describes his battles with alcohol
Near the end of that bleak November, I sat drinking in my kitchen.…there was enough gin concealed about the house to carry me through that night and the next day, (AAWS 2001, pg.3)
While this may sound opaque, often in recovery, it is through the recognition of the problem with do AA members, “achieve the continuing independence of freedom from addiction to alcohol,” (Kurtz, 1982, pg.33)
If not uniquely but certainly effectively, AA combines techniques such as comradery—AA is a fellowship—role models—one is asked to seek a sponsor to provide encouragement and support—spiritual awareness—such as the surrendering to a higher power (Dossett, 2013)— and total abstinence. These faucets bring together a methodology that has observable effects at decreasing substance abuse (Humphreys, Blodgett, Wagner, 2014). AA places substantial emphasis on the acholic being powerlessness over his or her addiction and that is through a journey, through the 12 steps (see image above) one can achieve sobriety or recovery (Friends in Recovery, 1989). Powerlessness is not used to deride members or even superimpose a moral or religious judgement on members, nor does AA officially confer the term disease to alcoholism, rather treats alcoholism as an illness that can be managed but not cured (Alcoholics Anonymous World Services, 2017).
AA has been shown to be as effective as other forms of intervention (Abraha, & Cusi, 2012) and a detailed review of AA literature found that abstinence was two times higher amongst those who attended AA meetings (Kaskutas, 2009) while also leading to a short to long term decrease in consumption (Humphreys, Blodgett, Wagner 2014). Although the confidentiality of meetings makes empirical research difficult (Vaillant, 2005) one can argue that this total anonymity allows for all manners of individuals from all walks of live manage and recover from their illness without social or class restraints.
The language of AA is indeed spiritual;one cannot deny that AA was founded on Christian principles (Kurtz, 1982)—and as a result has contributed to cult accusations against the Fellowship (Alexander & Rollins, 1984). However, in a letter to Bill Wilson, Dr. C.G Jung writes, “An ordinary man, not protected by an action from above and isolated in society, cannot resist the power of evil,” (Jung & May, 1963, pg.3) In other words, an individual is not moved by his or her volition, neurology or behaviour alone, and, despite the arguments made from secular quarters, the AA model works by facilitating sobriety through the surrendering to, or directing towards, a higher power, purpose, or meaning (Friends in Recovery, 1989).
Conclusion
This essay has examined one perspective of the fundamental associations between addiction and its causality. While there exist other models that describe addiction differently, and more may someday be theorised, the postulation that addiction is an illness stemming from a multifaceted network of modalities—neurological, genetic, and social—is a model that benefits from a diverse church of causes that allow for treatment. Rather than attributing addiction to one’s behaviour, we have seen how AA encourages both acceptance and surrender as a priori prerequisites for the successful management of a disease that is innate to the addict’s neurophysiology.
References
AAWS. (2001). Alcoholics Anonymous. Alcoholics Anonymous World Services.
Abraha, I., & Cusi, C. (2012). Alcoholics Anonymous and Other 12-Step Programmes for Alcohol Dependence1. Alcohol and Drug Misuse, 8–9. https://doi.org/10.1002/9781118454503.ch3
Alcoholics Anonymous World Services, I. (2017). This Is A.A....an introduction to the A.A. recovery program (p. 24). AA Grapevine, Inc. https://www.aa.org/assets/en_US/p-1_thisisaa1.pdf
Alexander, F., & Rollins, M. (1984). Alcoholics Anonymous: the unseen cult. California Sociologist, 7(1), 33-48.
Allgeier, A. (1996). Sexual Addiction: Disease or Denigration ? The Journal of Sex Research, 33(2), 166.
American Society of Addiction Medicine. (2019). Definition of Addiction. Retrieved January 2, 2020, from https://www.asam.org/resources/definition-of-addiction
Close, L., Thomas, S., Kelley, R., Stein, S., Osbourne, N., & Ackermann, K. (2020). Why Addiction Is Considered a Disease - Recovery First Treatment Center. Retrieved 2 January 2020, from https://www.recoveryfirst.org/why-addiction-is-a-disease/
Danesh-Meyer, H. V., & Levin, L. A. (2015). Glaucoma as a neurodegenerative disease. Journal of Neuro-Ophthalmology, 35, S22–S28. https://doi.org/10.1097/WNO.0000000000000293
Dodes , L. (2011, December 17). Is Addiction Really a Disease? Retrieved January 2, 2020, from https://www.psychologytoday.com/us/blog/the-heart-addiction/201112/is-addiction-really-disease.
Dossett, W. (2013). Addiction, spirituality and 12-step programmes. International Social Work, 56(3), 369–383. https://doi.org/10.1177/0020872813475689
Friends in Recovery. (1989). The 12 Steps for Adult Children (2nd ed.). San Diego Recovery Publications, Inc.
Harding, G. (1986). Constructing addiction as a moral failing. Sociology of Health & Illness, 8(1), 75–85.
Hitchens, P. (2020). PETER HITCHENS: Think flogging drug dealers is barbaric? We could soon be doing MUCH worse here - Mail Online - Peter Hitchens blog. Retrieved 2 January 2020, from https://hitchensblog.mailonsunday.co.uk/2019/01/peter-hitchens-think-flogging-drug-dealers-is-barbaric-we-could-soon-be-doing-much-worse-here-1.html
Humphreys, K., Blodgett, J. C., & Wagner, T. H. (2014). Estimating the efficacy of alcoholics anonymous without self-selection bias: An instrumental variables re-analysis of randomized clinical trials. Alcoholism: Clinical and Experimental Research, 38(11), 2688–2694. https://doi.org/10.1111/acer.12557
Humphreys, K., Blodgett, J. C., & Wagner, T. H. (2014). Estimating the efficacy of alcoholics anonymous without self-selection bias: An instrumental variables re-analysis of randomized clinical trials. Alcoholism: Clinical and Experimental Research, 38(11), 2688–2694. https://doi.org/10.1111/acer.12557
Hyman, S. E. (2005). Addiction: A disease of learning and memory. American Journal of Psychiatry, 162(8), 1414–1422. https://doi.org/10.1176/appi.ajp.162.8.1414
Jung, D. C., & May, I. (1963). The Bill W.—Carl Jung Letters. AA Grapevine, 19(8), 2.
Kaskutas, L. A. (2009). Alcoholics Anonymous effectiveness: Faith meets science. Journal of addictive diseases, 28(2), 145-157.
Kurtz, E. (1982). Why A.A. works. The intellectual significance of Alcoholics Anonymous. Journal of Studies on Alcohol, 43(1), 38–80. https://doi.org/10.15288/jsa.1982.43.38
Matthews, D. (2019, April 28). The black/white marijuana arrest gap, in nine charts. Retrieved January 2, 2020, from https://www.washingtonpost.com/news/wonk/wp/2013/06/04/the-blackwhite-marijuana-arrest-gap-in-nine-charts/.
McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness implications for treatment, insurance, and outcomes evaluation. Journal of the American Medical Association, 284(13), 1689–1695. https://doi.org/10.1001/jama.284.13.1689
Monico, N. Thomas, S. (2019). The 12 Steps Of AA | Alcoholics Anonymous Program. Retrieved 7 January 2020, from https://www.alcohol.org/alcoholics-anonymous/
National Institutes of Health. (2019). How Genes Work. In U.S. National Library of Medicine (Ed.), Help Me Understand Genetics. Lister Hill: Department of Health & Human Services. Retrieved from https://ghr.nlm.nih.gov/
Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374(4), 363–371. https://doi.org/10.1056/NEJMra1511480
Volkow, N. D., Wang, G. J., Fowler, J. S., Logan, J., Gatley, S. J.,
Hitzemann, R., ... & Pappas, N. (1997). Decreased striatal dopaminergic responsiveness in detoxified cocaine-dependent subjects. Nature, 386(6627), 830.
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